Infection at the Wrist is NOT a Contraindication to Supraclavicular Nerve Block
A wrist infection does not contraindicate a supraclavicular nerve block because the infection is remote from the block site, and only infection at the actual puncture site is an absolute contraindication to regional anesthesia. 1
Key Principle: Site-Specific Contraindication
Active infection at the injection site itself is the only infection-related absolute contraindication for nerve blocks. 1 This means the infection must be located where the needle will be inserted—in this case, the supraclavicular region.
A wrist infection is anatomically distant from the supraclavicular block site (which targets the brachial plexus above the clavicle), making it irrelevant to the decision to perform the block. 1
Supporting Evidence on Remote Infections
Regional anesthesia techniques show a low incidence of central nervous system infection (0.007% to 0.6%) even in patients with ongoing bacteremia or active infectious processes elsewhere in the body. 2
The risk-benefit ratio should guide decision-making when infection exists at a site remote from the puncture location, rather than strict contraindications. 2
Neuraxial and peripheral nerve blocks have been safely performed in patients with systemic infections when appropriate antibiotic therapy has been initiated and the puncture site itself is not infected. 2
Critical Safety Requirements for the Block
When performing a supraclavicular block in any patient, regardless of remote infection:
Ultrasound guidance is mandatory to reduce local anesthetic systemic toxicity risk and improve safety. 1, 3
An experienced operator must perform the technique. 1
Calculate safe local anesthetic dose based on patient weight. 1, 4
Immediate resuscitation equipment must be available. 1
Important Caveats
If the patient has systemic sepsis with hemodynamic instability or coagulopathy, this creates separate contraindications that must be addressed (thrombocytopenia, bleeding disorders). 1
Ensure the supraclavicular puncture site itself has no signs of local infection (erythema, warmth, purulence). 1
Consider whether the patient is on anticoagulation for sepsis-related complications, as this would contraindicate deep blocks like supraclavicular approaches. 1, 3